Hippotherapy and Therapeutic Horseback Riding

Hippotherapy refers to the use of horseback riding as a treatment for medical conditions. Therapeutic horseback riding, a treatment similar to hippotherapy, aims to both provide this treatment and to train people in proper riding technique.

Horseback riding has a long history as a therapeutic intervention. In the fifth century B.C., it was used in Greece to help rehabilitate wounded soldiers. The English also used horseback riding to treat soldiers injured in World War I. In the mid-20th century, a Danish woman, Liz Hartel, used horseback riding to overcome struggles with polio. She eventually won the silver medal in dressage at the 1952 Olympic games.

Horseback riding as therapy was introduced to the United States in 1969. At that time, the first hippotherapy center was opened in Michigan. Since then, this therapy has grown in popularity, with over 600 accredited riding centers currently open in the United States.

Treatment Approach

Therapeutic riding and hippotherapy are often done in addition to more conventional physical therapy. In this type of therapy, a person is positioned on a horse, typically with bareback pads and handholds for stability. A therapist monitors the individual on the horse. Conventional riding positions may be used in addition to sitting or lying sideways or backwards. The animal’s movements force the rider to respond with their own body movements. In hippotherapy, the therapist controls the horse, either from the ground or on the horse. The rider is not supposed to try to control the horse.

Evaluation in MS and Other Conditions

Hippotherapy is thought to be effective for treating walking difficulties. The rhythmic movements of the rider’s pelvis are similar to those used for walking. Some research suggests that 100 movements are transmitted to the rider for every minute of riding. Psychological benefits are also seen in response to this therapy. This may result from the recreational time spent outdoors as wells as the relationships formed with the therapist, other riders, and the horse.

Few studies have evaluated the efficacy of this therapy for people with MS. A small Swedish study found that some people treated with riding therapy exhibited improvement in balance, emotional functioning, pain, and muscle stiffness. This study also found that there was high variability between people. Therefore, an individualized approach to treatment is important. In 1988, another small study found riding improved mood and walking ability. Some preliminary work, presented at an MS conference in 1999, noted improved balance and quality of life.

Hippotherapy has been researched as a therapy option for several other conditions. It has been studied extensively in children with cerebral palsy. People with cerebral palsy have some of the same neurologic difficulties as those with MS, such as walking problems, muscle stiffness, and weakness. One German study evaluated the treatment of people with significant arm or leg weakness. Improvement was noted with muscle stiffness, bladder and bowel function, sleep, and mood. Another study of riding therapy for children with language disorders found improvement in self-esteem and language ability.

Although hippotherapy and therapeutic horseback riding have been studied in many conditions, including MS, the beneficial results have been suggestive but not conclusive. Further research needs to be conducted to produce more definitive results.

Adverse Effects

Horseback riding in any situation carries with it the risk of falling off the horse. People who are particularly unstable should avoid hippotherapy because they are at an increased risk of falling. For some with difficulty sitting, problems with head control, or severe spasticity, riding may not be possible. Sometimes riding is done in hot weather–these situations should be avoided by those with extreme fatigue and people whose symptoms are exacerbated by heat.

The American Hippotherapy Association suggests that therapy be done cautiously for anyone with diabetes, obesity, hip joints conditions, heart disease, mild to moderate osteoporosis, incontinence, recent surgery, or allergies to dust or horsehair. They also recommend that people with bone fractures, osteoporosis, instability of the spine, herniated disks, severe arthritis, seizures, sores on weight-bearing surfaces, and people using anticoagulants avoid hippotherapy altogether.


Therapeutic horseback riding and hippotherapy are relatively low-risk, moderately expensive therapies. The results of the research are not definitive, but these therapies may offer benefits for walking difficulties, weakness, spasticity, bowel and bladder issues, and depression.

References and Additional Reading


Bowling AC. Complementary and Alternative Medicine and Multiple Sclerosis. New York: Demos, 2007, pp. 146-149.

Journal Articles

Bertoti DB. Effect of therapeutic horseback riding on posture in children with cerebral palsy. Phys Ther 1988;68:1505–1512.

Hammer A, Nilsagard Y, Forsberg A, et al. Evaluation of therapeutic riding (Sweden)/ hippotherapy (United States). A single-subject experimental design study replicated in eleven patients with multiple sclerosis. Physiother Theory Prac 2005;1:51–77.

MacKinnon JR, Noh S, Lariviere J, et al. A study of therapeutic effects of horseback

riding for children with cerebral palsy. Phys Occup Ther Ped 1995;15:17–31.

MacKinnon JR, Noh S, Laliberte D, et al. Therapeutic horseback riding: a review of

the literature. Phys Occup Ther Ped 1995;15:1–15.

McGibbon NH, Andrade C-K, Widener G, et al. Effect of an equine-movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: a pilot study. Dev Med Child Neurol1998;40:754–762.

Meregillano G. Hippotherapy. Phys Med Rehabil Clin N Amer 2004;15:843–854. Pauw J. Therapeutic horseback riding studies: problems experienced by researchers. Physiother 2000;86:523–527.

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